Book Reviews

Most occupational medicine physicians understand the substantial links between workforce health and productivity, and also the value of health and productivity management (HPM). Business leaders generally agree, stating that people are their most important asset. Unfortunately, few physicians enjoy business relationships that pay more for the high quality health outcomes that drive workforce productivity. Why? Most importantly, because we lack the credible systems of measuring and valuing health and health-related productivity in a specific workforce. Measuring the asset value of human capital is fundamental to the business case for buying those health care services that increase health, and for avoiding those that consume resources with little benefit. Ronald C. Kessler, professor of health care policy at Harvard Medical School, and Paul E. Stang, PhD, epidemiologist at the University of North Carolina, Chapel Hill, School of Public Health, have published the most compelling case to date for business investments that costeffectively improve worker health. Their thesis: employee health is “a human capital investment opportunity that needs to be optimized, not a benefit cost to be contained.” They predict that effective management of investments in health outcomes will become an important source of business competitive advantage, and a core competency. To that end, prevention and optimal disease management are the high value outcome categories. Moreover, digital health information technology is fundamental to the use of these tools, and to this future. Part one provides a detailed review of the evolving measurement tools that now allow a credible, affordable, practical, reasonably accurate, and company-specific dollar valuation of the increased productivity possible from an optimally healthy workforce:

We have inserted this gentleman's titles at length, though ?we doubt, that even their authority will not secure him from being ranked amongst the Charlatans'whose assertions astonish the weak and convince the credulous alone. We must however admit that he has opened an extensive field of inquiry, and cannot be justly condemned till ^ve have gone over tiie same ground and proved his experiments to be false.
The mode of introducing medicinal substances into the system by means of friction lias been explained, and many facts in support of its utility and eflicacy hf?ve been stated from time to time in this Journal, by Mr. W ard, who has lately republished them in a separate volume with additional matter. We are, therefore, prepared to admit many facts related by Dr. Chreslien, w hich we might otherwise have disputed. Certainly he has pushed the practice much further, and appears to have derived much more success from it, than any author whom we have yet read on the subject. From the introduction we learn that this is I he third impression of his Observations sur few p/oi des rtmedes a t\\vte,rieur; and that he has each time, altered the title ol his book ; the first, Methode par Absorption, was improper, because the action of absorption is independent of friction.
In some instances the skin absorbs the medicament rubbed upon it; in others the remedy acts by sympathy; or the effect may be produced by the friction merely* The second edition appeared with the title of Methode Jatroliptice, but an erudite friend, persuaded the author this was an ChresticHj Methode Jatraleptique. ? 315 improper term; lie bus, therefore* substituted Jatraleptique for Jatroliptice, which lie had found in Jair.esV dictionary, and which is certainly as expressive as the epithet he has J1o\v adopted.
" Strange that such difference should be Betwixt a little c and t !" It seems as impossible fora Frenchman to write without boasting, as to harrangue without grimace; Dr. Chrestien is sufficiently dillidcut of his pretensions to science, but. extremely eager to convince us that his probity is unquestion-:'!'le.
Si je jouis de quelque consideration, (s'lys he) comme. ^'edicin practicien, j'en jouis encore plus comme homme probe, delicat et de?iuteresse ; et si le degre de science depenuait de moi comme la probitc, ladelicatesse et le desint.eressejnentj je nc cederais en savoir a aucun Medicin comm." This, *rom a native of any other country, would have caused us to s"spect that the author might possess any quality than that ^hich he so much vaunted ; but in a French writer it is mere Usage, and we are as willing to believe the Doctor, as we Were previous to his intimation, that lie is the most delicate, disinterested, and veracious writer in existence. rhe author commences the detail of his cases and experiments with Camphor; which he directed to be mixed with S;uiva, and rubbed in on the inner part of the thighs in doses ?' eight or twelve grains. The first case was an irritation in ^le urinary passages from the action of Cant ha titles on the skin, produced 011 the Doctor's own person ; who, being attacked Avi<h sciatica, caused the part affected to be rubbed with forty Sraips of Cantharides finely powdered and mixed with saliva, the effects of which he thus states : " La friction admiqistree par une main vigoureuse, armee d'un gant e peau de daim, fut forte et long-temps cont'nuee. Je ressentis 1'efFet assez ordinaire des cantharides sur les voies urinaires. II me tit plus souftrir que la chaleur vive que j'epiouvais sur la partie frictionnee. JLa "U1t fut inquiete, l'operation ayant ece pratiqutSe au moment de me me't-^.r.e au lit. ?,e calme n'etant point retabli al'heure de mon lever, je me tr>ctionnai la partie interne de la cuisse avec douze grains de Camphre j^eles a la salive. Dans un instant l'absorptiou fut faite; quelques cures apres, mon etat fut moins penible. Ayant repe'tc ma friction camphree le soir, la nuit fut tranquille, et a mon re veil, je me trouvai Qans une position contraire a cette de la veille." . Since that period the Doctor has never been disappointed 1,1 the effects of Camphor counteracting those of Cantharides 0n the urinary passages. fte.vre ardenle compliquee de la gastro-bilfeuse Jj/piriqt/e ; and in fevers "oi various descriptions, as catarrhal, remittent, bilions,'&c. &c. Jn all ot these the effects of the remedy were admirable, but we cannot explain the mode in which it operated. Dr. C.m general being content with informing us that the symptoms.subsided, or the violence of the disorder abated soon after the friction.
A female, aged 36, ol violent character, of a sanguine-bilious temperament, subject to trcquent attacks of epilepsy? was seized <ftine delire fr tieliqut si furieux, that she was obliged to lie tied down in bed to prevent her throwing herself upon die attendants, or leaping out of window, which she attempted more than puce. Dr. Chrestien being sent for, directed twenty grains of Camphor mixed with saliva, to be rubbed on the inner part'of each thigh ; and to be repeated every two hours, in two hours the patient was so much better that she was unbound.
When two drams of the Camphor had been used, !e c.a'me fi/t par fait. The same means were resorted to so r e mouths afterwards, and succeeded in preventing a return oi the complaint with which she was threatened.
Chresticn, Methode Jatraleptiqiie. 317 . 1 he utility of the external application of opium is sufficiently familiar to us. Dr. Chresticn remarks that he found 7.Cry tew individuals in whom opium, administered by fnc-,l.?nj produced narcotic effects. He frequently used a cornnation of opium and camphor in brandy with good effect, .I relates many instances of its success, in suppression of le catamenia and various other diseases.
Jn the application of Colocynthis by friction, in mania, jJ.e Relieve the author is completely original; he commences Vs tjrst case, by observing, " Ennemi du mensonge et du ^Jatahisme, je vais rapporter lcs faits tels qu'ils sont." fi e patient was a woman aged 40, who had been for some ' ys subject to mania ; the fits were occasionally marked by ii?i ? melancholy ; occasionally by a taciturnity which llng could disturb; and sometimes by furious delirium.
r-Chrestien found her without fever; the bowels were cose' the skin soft, but without sensible transpiration. She l'sed all solid food, and took liquids with reluctance. .No Use3 except a catar h with cold-shivering and a swelling n the right cheek, could be assigned for the malady. The . ,Iledies employed procured no relief. In consequence of e obstinate constipation, the author ordered sixty drops of ? tincture of Colocynthis (teinlure de cofoquinle) to be flo ?n *',e belly ' n0 e^ect was produced but an increased w ?f urine. The following morning the friction was re-jM and a purgative given internally, which succeeded signing the bowels ; but the alvine evacuation was incon-Af('ra^e' aa(l the amendment of the patient was but slight.
ftl,-Cr sorne days, no remedies being given, the patient rebitf?? drink, or to take any kind of nourishment, the ^ er~apple was again repeated in substance in the dose of ei?ty grains, mixed with lard, and continued daily for rent when the maniacal state yielded ; the only appaeffect produced by the frictions, appeared to be an inei?jSC ?* turbid urine. The frictions were continued for tK5 '/ ^!l^s 'on?cr5 without opening the bowels or occasioning aiH t sensation ; the patient regained her former faculties, Xh gained sleep to which she had long been a stranger. e oowels remaining costive, notwithstanding the frictions, c/f-s VVere '"jected, and brought away " dc matteres dur-Several other cases of this sort are related ; some of them Petitioners who were induced to try the remedy upon ? Chrestien's authority. In most of these the bowels reef.-constipated during the frictions, whilst the discharge Tjlne Wa<i augmented. le author's experiments with Digitalis in cases of dropsy. were.

3IS
Critical Analysis. tvcrc also very successful, and a case of ascites combined with anasarca, which had resisted the frictions with the lin^" ture of Digitalis, was happily cured by a decoction of it thrown up the rectum by injection. We shall give an extinct from this extraordinary narrative in the author's o\Wl words.
" Lcs frictions avec la teinture de digitale, si elles n'avaient pas e(C sans eff'et, n'avaient servi qu'a ralentirles progres du mal, qui etoit ccpendant parvenu au point de faire craindre me mort prochaine. Ayan^ propose a M. Mejan, iricdecin praticien du premier mcrite de none v:He> de iaire l'essai de la dccoction de digitale pourpree, injectce dans l'anus* ij v consentit. La dccoction fut prcpaice avec deux gros de cette plante pour quatre onces de colature, et employee trois fois le jour, au moye^ i d'une petite seringue a injection qu'on ne vidoit qu'une seule fois i chaque operation. L,a dose de digitale fut de trois gros en renouvcl^ la decoction ; et enfin de demi-once. A peine la troisieme dose fut" elle cpuisee, qu'il survint un flux d'urine si considerable, que dans trente* six heures le malade en rendit vingt pintes. Les enflures se dissipe" rent, et l'epanchement parut ne plus exister. " Quelques mois apres cette heureuse crise, les memes phenomena ayant reparu, l'emploi de la decoction de digitale a demi once p?ur quatres or>ces de colature, eut le meme succes que la premiere fois." Many pages of this volume are occupied with practical remarks upon Cinchona. The author employed the tincture of it in friction with advantage in cases of rheumatism, intermittent fever, <Src. ; and suspecting from the little bark con' tained in the tincture, that the effect might be produced by the application of the spirit merely, he substituted a mixture of brandy and spirit of wine, but it was of no use in intermit' tent fever.
lie has detailed many cases in which he gave the resin or extract of bark internally. The chief advantage consists in a small dose being sufficient.
We now come to the wonderful wonder, or noirceau remade anti-venerien. The author prepares us for the golden novelty* by observing that accident has often effected the most important. discoveries; theaccident which succeeded in the present instance was simple enough ; and accords with Pliny's remark* <? nullum esse librum tain malum, ut non aliqua parte pro? desset." Dr. Chrcstien, it seems, had read many trealiscs upon syphilis, some of the authors of which attributed the curative effect of mercury to its Avcight. The Doctor did lend implicit faith to this opinion ; but. without stopping t? inquire in what way mercury does act, lie rather sagaciously thought, that if it were true that this mineral cures by i|s heaviness, gold being more ponderous, ought to be more efficacious. Consulting different writers on Materia Medica, h? found them concur in stating, that as a medicament, gol(I I Chresiien, Mtlhode Jatraleptique. 319 useless or dangerous. On this account, and not.exactly knowing what preparation of the metal to use, lie relinquished ."isdesign for some vears; when on perusing Clare s treatise 011 J'ie use of calomel rubbed within the mouth, he felt a strong, desire to make the experiment which he had not yet essayed. _ lie accordingly prepared an amalgam of gold, and volatilized the mercury, by the action ot heat, and occasionally ^yith nitric acid. The effect in either case was successful. "<; commenced his experiments upon paupers, and was astonished at, the salutary effects of the remedy. Being utterly l,,capab!e of explaining them, he consoled himself with a \v'ise saying of his master. M. de Lamure,?" Le vrai mc-Uecia, me'disait mou oracle, n'est pas celui qui explique la inaniere d'agir d'un remede, mais celui qui saisit bien les indications, qui fait les applications a propos, et qui en observe judicieusement les effets and with great naivete concluded, " ,}e renoncai a toute explication." Although Ur. Chrestien might be convinced that no parties <>f mercury remained in combination with the gold, the Public might be more incredulous, especially since Fourcroy 1,a<l pronounced it was impossible completely to disengage the gold from every particle of the mercury with which it had ^en amalgamated Dr. C. therefore, to obviate the; possibility ot attribuiW his cures to the mercury which might still regain combined with the gold, prepared an oxide of this me* tal, by precipitating a solution of it in nitro-muriatic acid, w'th potass. lie also prepared an oxide precipitated by tin ; and some years afterwards, a muriate of gold.* Of U, ese preparations, the three first appear to be posted of nearly equal powers, and were administered by trie-,'?n on the gums, inside the mouth, &c. by friction, to the Extent of threw grains in the day. The muriate was more de-Wescent and highly caustic. " This induced Dr. C. to com-blI1e it with muriate ot soda ; lie thus obtained a triple compound, more convenient for use, possessing the same propert,es5 but in greater degree than the other preparations of the Precious metal. The usual dose of the triple muriate of gold ail(l soda was the fifteenth of a grain; it never could be Pushed beyond a tenth without exciting fever, irritation, and ^lflajnniatory svmptoms. In some cases it was found advantageous to use the muriate and the.oxide at the same time.
.'I'he appearances of syphilis being familiar to most practitioners, it is unnecessary to extract any of the numerous * We shall, on a future occasion, have an. opportunity of explaining ese preparations more minutely.?Eo.
cases 220 Critical Analysis. < eases recorded in the volume before us, of every form of the disease from blenorrhcea 1o long-standing confirmed lues* The complaint yielded to the gold in most instances sooner than tinder similar circumstances of severity it would liavC done to mercury.
hen the triple muriate was employed in general, three grains sufficed. During the use of the remedy neither confinement nor alteration of regimen were cessary. Patients of either sex, and of any temperament, may employ it at all seasons of the year; and whilst under its action topical applications' were seldom required, chancres healing, and worts disappearing by simply observing cleanliness. The patient is directed to retain the medicine in tb<?
mouth for one minute after friction, though no harm will accrue from swallowing it. It may be applied to any pa^ within the mouth, taking care only to avoid the teeth. three instances the author was obliged to have recourse to a different method; the patients were scorbutic, and blood flowed on the slightest friction. In females he observes we have " tine voic de plus, celle de la face interne des grander levrcs; j'y ai eu recours une fois seulement et avec succes, la femme qui avoit besoiu d'un traitement anti-venerien n'ayant' jamais voulu consentir a porter le remede dans la bouche de peur de se la gater." Besides this remarkable influence upon venereal affections* the remedy operates beneficially upon glandular swellings? and schirrous womb. The following case is less wondeifu' than many others which we might have quoted. A woman aged twenty-two, who had borne one child, ap' plied to Dr. Chrestien for a complaint which he considered as a serious affection of the womb. An examination being made by Messrs. Bourquenod, Laborie, and Fages, they discovered a schirrous tumour of considerable size. M. Laborie had found -'he womb in the same state six months before ; but notwithstanding the remedies employed, at the period of the second examination, her pains had become more severe. She now began the friction of half a grain of the oxide of gold) gradually increasing it to one grain. In forty-five dnys M* Fages ascertained by examination tljat the tumour was sensibly diminished. The treatment bemg continued ten weeks* M. Laborie found that the happy change observed by Fages was confirmed. After persevering in the plan four months, the patient being free from all pain and ailment, declined to continue the remedy. Being examined by Messrs. Laborie and Fages, they found the tumour had diminished two thirds. She had used no other remedy or application than the oxide, and had no indication of uterine disease ten years after discontinuing it, .

321
In concluding this hasty sketch of a work abounding in ^traordinary statements, it becomes us to mention that Dr.
^hrestien ranks high as a practitioner, is much consulted, a,ui would rather stiller than gain by false assertions. prcscriber. But wherefore all this ? money, notoriety, funic and?public good, is (lie impulse. Yet in this motley host there is no individual, perhaps, but may confer some benefit on society. The multitude draws attention to the subject, and as this tide in the affairs oftlie men rolls along, some happy genius may be swept into the flood. For adding to a cata* logue already, in his own opinioiij too long, the author of the London Dispensatory offers an apologetical explanation. I11 its general plan and arrangement the London Dispensatory resembles closely the Edinburgh, by Duncan ; but though Mr. Thomson has not thought it expedient to deviate from that established work, he has gone more largely into some parts, and those we thinkj of essential importance. "I trust," he says, " that the alterations and additions which I have introduced, particularly in t he history of the Materia Medicalwill give a legitimate value'to tin* London Dispensatory} 524.
Critical Analysis. ecting the constitution of the muriatic anil oxymuriatic acids* e has cautiously withheld hisopinion. The object anil intention of the work, and the means to bp employed in its execution being adjusted, perspicuity in defail is accomplished,by the following arrangement. Three General Heads, Elements of Pharmacy-^-Ma?eria Medicare Preparations and Compounds'; with their subdivisions, serve to arrange-and martial the specific descriptions. The first Head, Elements of Pharmacy, is divided into three Sections.
Sects 1. Attraction, under the distinct forms of ?>g" gregation and affinity. Repulsion and the powers producing it, as caloric, light, and electricity. Sect. 2. Constitution and combination of substances, under solids, fluids, and gases. Sect. 3. Pharmaceutical operations and apparatus. As aspecimen of this Plead we copy the observations on Electricity and Galvanism, because the subject has at this moment a peculiar interest.
" The phenomena of Electricity depend on a very subtile fluid, which is a powerful chemical agent, capable of producing immediate decompositions and new combinations. Galvanism appears to be essentially the same as Electricity, differing, however, in some degree in its effects and the mode of production. Both are to be regarded as repul* sive powers. " Electricity may be communicated to all substances : by some it ?3 transmitted without any perceivable obstruction, but by others with much difficulty: hence bodies in their relation to Electricity are distinguished into two classes, conductors and non-conductorsand as >t can be accumulated in the latter by friction and other means, these are also denominated electrics ; while the former are denominated non-electrics, to indicate their inability of being excited. " The chemical effects of Electricity seem to depend chiefly on its power of producing a sudden high temperature ; and this appears to be proportioned to the resistance opposed to its transmission, 'it often favors chemical combinations, as' that of oxygen'with metals, and promotes the instantaneous chemical union of gaseous bodies. It also effects chemical decompositions, as those of water, ammonia, alcholiol, and metaUid oxides. " Galvanism may be regarded as a modification of Electricity, 10 which the fluid is evolved during certain chemical actions. It is transmitted through those substances which are conductors of common Electricity, and with the same degree of facility and rapidity. The metals, charcoal to a certain extent, plumbago, water, saline solutions, and the greater number of liquids, are conductors ; but glass, dried and baked woods, th? dry animal cuticle, and dry gases are non-conductors 6P the galvanic fluid. As a chemical agent, Galvanism is the most powerful of all the repulsive forces, and is capable of producing decompositions which could not otherwise be effected.1 By its means the chemical constitution of the alkalies and the earths has been established, and their bases discovered to be substances hitherto-unknown, which ? V: ' hare Thomson's Dispensatory. 525 have been added to Hie list of metals. Galvanism, like Electricity, acts as a stimulus to the living system. Its effects on the animal body are, a *ensation of light when applied to the eye; a sensation of acidity on the tongue ; and ihe excitement of strong muscular action." five plates of pharmaceutical apparatus, of particularly correct ami spirited outline, are attached to this division of Hie work. riie second part, or what has, perhaps, been toqconfinedly bailed (he Materia Mediea, forms the most interesting division (?1 the volume; and in this, its connectcd with natural history ,u,(l botany, will be more particularly seen, what Mr. Thorn* ??n conceives to be an improved method of treating the sub" Jcet By giving the article on the genus Cinchona, we shall present our readers with, w hat we admit to be, an advantage* <),,s specimen of ihe author's execution of his design. lxvii. 504 t. 10 lf This important genus is not yet altogether freed from the ambiguity Which has so long involved it; and although much has been effected ? by the industry of the Spanish botanists whom their government sent out to make inquiries concerning it, yet many species remain undescribed*, .from which it is very probable the bark-gatherers collect some part cf the large cargoes which are annually sent to Europef. The three kinds * In a large collection of dried specimens of the genus Cinchona in my possession, which were collected in laOij, both near Loxa and Santa Fc, I find several species'which are not mentioned in the works of any of the Spanish botanists. + Humboldt informs us that the quantity of cinchona hark annually escorted froir. America is 12.000or 14,000 quintals. The kingdom of Santa F? furnishes 2.000 of these, which are sent from Carthagc-na : 110 are furnished by t-oxa; an-j the provinces of Huamanga, Cuenca, and Jaen de liraeamornM, ^ith the thick forests of Guacabamba and Ayavaea, furnish the rest, which w shipped , 32G Critical Analysis*medicinally used have bee,n distinguished and named by MutK a eele' brated botanist who has resided in the neighbourhood of Santa Fe de Bogota since 1783, as director of the exportation of bark; and his observations have been fully detailed by his pupil Zea; whilst the travels of Humboldt and Bonpland have afforded them an opportunity of ascertaining accurately, and describing, the species first delineated by Condamine, and named by Linnseus c/flcinalis, under which term no lesS than four distinct species were confounded by that distinguished naturalist in the different editions of his system*. Under this trivial name also the British pharmacopoeias placed as varieties the three'barks known in the shops ; and this error is still retained by the Edinburgh and Dublin CoJleges; but in the last edition of its Pharmacopoeia the London College adopted the trivi.il names of Mutis and Zea ; and although, for the sake of uniformity, we have set down the two first species above, as named and arranged by Willdenow, yet we shall describe them under* the corrected appellations. Dub. Heart-leaved Cinchona ; (The common pale Bark of the shops.) The tree which affords this bark is found in the mountains of Quito and of Santa Fe, growing along their skirts, and on the plains; flowering from May to September. It is a spreading tree, rising on a single, erect, round stem of no great thickness; and covered with a smooth bark externally of a brownish grey colour. The younger branches are quadrangular, smooth, leafy, sulcated and tomentose: the leaves, which are-about nine inches in length, are opposite, petiolate, spreading, of an oblong-oval, cordate or egg-shape, entire, shining on the upper surface, ribbed and pubescent on the under: with the petioles flat on one side and roundish on the other, about a thumb's breadth in length, and of a pur: pie colour. The flowers appear in large, terminal, leafy panicles, supported on long compressed tetragonous peduncles. The calyx is fivetoothed, downy, and of a purple colour : the corolla internally tomentose ; the'tube of a diluted red colour ; the limb shaggy, white above and purplish below ; and the segments spreading, with reflecting tips. The filaments are short, supporting linear anthers, bifid at the base. The germen is tomentose, and changes to an oblong, narrow capsule, about one inch and a half in length, marked with ten striae, of a reddish brown colour, and crowned with the calyx.
The bark yielded by this tree is named Quiaa amarilla\ by the Spa- ?f-Yellow or pale bark; the adjective signifying both yellow and pale, or wan. The name appears to be us^d in contradistinction to ncrrunjada, orange colour, which is applied to the next officinal species. cjards. Two other varieties of it, probably produced by distinct species, are also known in commerce by the names of lagartado (lizard like) and ncgr'illo (blackish), from the colour of their epidermis. It has always been known in this country by the vague name of Peruvian or official bark; 2nd erroneously regarded as the kind produced by the tree ^hich was delineated by Condamine. It is decorticated in the dry season, from September to November, which is the period at which all the kinds are barked, and the bark is carefully dried in the sun. I ht trees generally die after the operation.
The bark arrives in Europe packed in chests made of slips of wood, roughly fastened together, and covered with -kins; each of which con-' la'ns about 200 lbs. weight, well packed, but generally containing a quantity of dust and other heterogeneous matter. It consists of pieces ?lght or ten inches in length, some of them scarcely one-tenth cf an inch jn thickness; singly and doubly quilled, or rolled inward, the quills ng scarcely larger than a swan's quill*; and others of a coarser texll?rej thicker and nearly flat. Both kinds have a chopped, greyish of ClneritiouS epidermis, often covered with flat, sometimes stringy lichens ; and internally of a cinnamon hue. They are evidently the bark of the same tree; the quilled sort being that of the smaller branches, and the "at that of the larger and the trunk. But the chests probably contain similar barks obtained from different specie^. . Qualities. Good bark of this description has scarcely any odour when ln substance; but during decoction the cdour is sensible, ahd agreeably Somatic. The taste is bitter, but not unpleasant, slightly acidulous and austere, resembling in some degree that of a dried rose. It is light, breaks with a close fracture, with the internal fibres somewhat "''awn out.
The powder is paler than the baik, of a fawn colour, or ? light cinnamon hue ; but the flat kind yields a deeper coloured and browner powder. The best specimen of this bark which could be pro-% cured by me, and subjected to experiment, gave the following results : "rater at 160? extracted all its active principles; affording an infusion* ^hen filtered, of a pale yellow or straw colour, which had the odour a?d taste of the bark. It reddened litmus paper; was instantly and Copiously precipitated by solution of galls; and in a smaller degiee, and m?re slowly, in yellowish flocculent flakes, by solution of isinglass. A ??lution of tartar'emetic was rendered turbid, and slowly precipitated by lt 5 but this effect was quicklv and copiously produced on superacetate of lead. Sulphate of iron changed its colour to bright olive-green, but ^as not precipitated. The powder macerated in sulphuric ether afforded a golden yellow tincture, which reddened litmus paper, and left a pellicle of bitter resin when evaporated on the surface of water, to ^hich it gave the colour of the tincture. This coloured water had the . avour of the watery infusion, but differed from it, in not precipitating tlle solution of galls and tartar emetic ; and in throwing down a copious precipitate from the solution of sulphate of iron. With alcohol the pow-* The great desire of our bark merchants t o procure quili bark has occasioned the bark gatherers often to produce this effect by heat, which never fails to 'niiuish the virtue of the bark* MS, of X)ok lelix Dcvoti of LAm.9, iu the au-l"or's possession. der 328 Critical Analysis* der afforded a tincture of a deep orange hue, which precipitated sulphate of iron, tartarized antimony, and tannin ; became turbid when added to water, and let fall a light reddish precipitate. From the effects of these re-agents on the aqueous infusion of this bat k, it appears to be the same as the 3d and 15th species examined by Vauquelin; which he names superior gray cinchona, ' ) " This tree is found on the Andes of Peru, near Ayavacam, growing at heights from 6/250 to 8,300 feet, where the mean temperature varies between 59 and 6'2 degrees, on a bottom of micaceous schist ip the woods of Caxanuma, Uritucinga, Villonaco, and Monge*. It J* a lofty handsome tree, always in leaf; and exudes, wherever it JS wounded, a yellow astringent juice. The trunk is about eighteen f<-'et in height and fifteen inches in diameter, erect, with a cracked ash-c?" loured bark; the branches are round, in opposite pairs, erect, brachiated 5 with the younger ones obscurely quadrangular at the nodes. The leave* are of a lively green, shining, oval, lanceolate, about three inches lon?> with a little pit in the axillas of the nerves on the under surface, which is filled with an astringent aqueous fluid, and having the orifice shut with hairs ; and they stand on footstalks one-sixth of their length, fl;lS ?bove, and convex below. The stipules are two, acute, silky, contiguous and caducous. The flowers, which are odorous, of a whitish rose colour, and furnished with little bractes, appear in terminal, brachiated, leafy, trichotomous panicles, supported on round peduncles and pedicles, that are powdered and silky. The calyx is of a globular bell shape, live-toothed, powdered and silky like the peduncles, with the teeth acute, very short, and contiguous-The corolla is somewhat salver-shaped, six times longer than the calyx, with the tube obscurely pentagonous, silky, more frequently of a rose colour ; the limb wheelshaped, with oval segments, much shorter than the tube, white an(l woolly above. The germen is globular, changing to an ovate, woody? i longitudinally striated capsule, crowned with the calycinal teeth, twocelled, many-seeded, oppositely twice furrowed, aud opening from tb? base to the apex with two valvjs. 44 This tree affords the original cinchona of Peru, which is now very rare, 110 quintals only being cut, instead of 4000 vthich was the quantity in 1779, and reset ved for the u-e of the Spanish government. Ze* says it is a variety of the lancifol'ta of Mutis, under which we have placed it ; and there is also a great affinity between it and the scrobicU' lata of Humboldt, according to that celebrated traveller. The bark ot the luntfolia is the yellow bark of the shops, the Quina Naranjada of * Annalcs dr. Chimie, lix. 116. * As theCori'laminta of Humboldt is evidently a variety, if not the samc species meant by Mutis, we hare availed ourselves of his accurate description? the Thomson's Dlspensasory. 329 the Spaniards. It is known in commerce by the name of Calisaya*; is preferred in South America to the pale cinchona. It is brought t0 this country in chests containing about 90 to 100 pounds each ; and consists of pieces about c-ight or ten inches in length, some quilled, but ^ greater p irt fl.cf The quilled pieces are less rolled and thicker an the quilled paie bark; and the epidermic, which is of a tawney g'aytsh brown colour, and covered with flat and stringy lichens, more f?ugh and chopped, easily separating, and often as thick as the bark tSn which is about one-eighth of an inch. The flat pieces are genea ly without any epidermis, and considerably thicker than the quilled : cth are mixed in the same chest.
Qualities. Yellow bark has nearly the same odour in decoction as e'pale ; the taste is more bitter, but less austere, and it does not af-0r. anV astringent feeling to the tongue when chewed. The internal ?lour is an orange cinmhnon, or subdued yellowish brown the fracre is woody and fibrous, pre enting, when examined by a lens, the aPP<?arance of parallel longitudinal needle-like fibres, with a dry agglo-?e'ated powder in the interstices of a yellow colour. It is easily re-^uced to fine powder, and the powder preserves the colour of the bark, ut is brighter. The filtered aqueous infusion has a pale golden hue, !tn a shade of red ; is clearer, and seemingly less mucilaginous thin the 0rnier: it has all rhe bitterness of the bark ; reddens litmus paper, and Precipitates solution of galls ; but the precipitate does not fall so instantaneously as in the infusion of the former species. With solution ? 'singlass a pinkish yellow precipitate is produced: supeiacetate of ead throws down a precipitate ; and that with tartarized antimony is ^ore copious-than tlie pale bark affords, and in yellowish white flakes. ~ solution of sulphate of iron changes its colour to a deeper green, and te>" many hours gives a precipitate of the same hue. The ethereal _ Hctufe has the same golden colour affords resin when evaporated, and ^ aliected by the same' reagents as that of the pale cinchona ; but the ?iter on which it is evaporated is less highly coloured. The alcoholic ncture appears to be in every respect the same as that afforded by the Pa e bark. It seems to agree in most of its properties with the first .pecies examined by Vauquelin ; which he states was brought to Spain *788, and, owing to its having been used for the royal family, got ^uanie of royal cinchona. woods on the banks of the mountain streams, in great abunJanet, at Chinchao, Cuchero, and Chacahuassi ; flowering in June and July. ^ rises tb a very considerable height on a single, erect, round stem, which ( is covered with smooth, brownish ash-coloured bark. The older branches are round, smooth, and of a rusty colour; the younger are obtusely four-cornered, leafy, and of a diluted reddish colour. The leaves are opposite, large, the full-sized ones being one or two feet in length, of an oblong oval shape, and supported on short semiround purple petioles. They are entire, pale, on the upper surface shining, on the under veined, with veins that turn to a purplish colour ; and at the base of each are numerous bundles of white bristles : the stipules are supraaxillary, interioliaceous, opposite, contiguous, united at the base, and of an obovate figure. The flowers appear in large, erect, much compounded terminal panicles, somewhat blanched, on long brachiated mapy-flowered peduncles. The calyx is small, live-toothed, and of a purple Colour ; the corolla white and odorous, with the limb spreading} and hairy within : and the filaments are inserted into the tube of the corolla, and support oblong anthers bifid at the base. The capsules are large, oblong, obscurely striated, sligluly curved, and crowned with the calyx.* This tree is named in the vernacular Spanish Case milla dc jlor dt , vlza/iar, from the flowers resembling in odour those of the orange ; and its bark is the Quir.a roxa and Colorado, of commerce. The bark Is brought to this country in chests, which contain from 100 to 150 lbs. each. It consists of large thick pieces, covered with a thin and rough entire reddish brown epidermis. The greater number of the pieces is flat, but some are partially quilled, as if taken from half the circumference of the branches to which they belonged. Under the epidermis there is an intermediate layer, which is dark coloured, compact, brittle, and seemingly resinous ; and within it the internal part is woody, fibrous, and of a rust-red colour. The fracture, examined by a lens, consists of close longitudinal parallel needle-form flbrillae of a pale red colour, with a deep red agglomerated powder in the interstices. The powder is of a deeper colour than the internal part of the bark. " Qualities. Red cinchona bark has a weak peculiar odour ; and its taste is much less bitter, but more austere and nauseous, than the two former species. The aqueous infusion has a pale ruby colour, a slight degree of bitterness, and a decided astringency. It reddens litmus paper-f-, is slowly precipitated by the solution of galls, the supernatant liquor being perfectly colourless; and a very light, floceulent, rubycoloured precipitate is produced by the solution of isinglass : it is not altered by tartarized antimony, nor by the seperacetate of lead ; and the sulphate of iron makes it assume a dirty yellow olive colour only? without being precipitated. The ethereal tinctuieis of the same colour, and exhibits the same appearances as that of the two former ?pe" cies, when treated in a similar manner. The alcoholic is of a very deep brownish red colour; when diluted with water a red flocculent * Flora Pernv. ii. 53. t. ISfi. + Fourcroy found in it a portion of citric acid, some muriate of aitiffl"1"*' ?JU]ni.n ' and 'he third, thcise which precipitate at the same time tannin, fee atine, and tartar emetic. He conjectured that on the principles pro* toeing these effects, particularly that which precipitates infusion of galls, j le 'ebrifue;e properties of the barks depend, and that they are more or ess remarkably febrifuge, in proportion to the quantity of these printi-P es that are present. He asserts that the principle which piecipitates tannin is of a brown colour and bitter taste ; is less soluble in waller I n in alcohol ; and it also precipitates tartarized antimony, but not SUef. It has some analogies with the resinous bodies, although it urnishes ammonia on distillation : whilst the principle which in some c'nchonas precipitates glue has a bitter and astringent taste; is more ?'Uole in water than the principle, which in other kinds precipitates ttln; and that it is also soluble in alcohol, and does not precipitate farp' err>etic;j;. Fabroni conceives that he is authorized to conclude from ls experinients, that " the febrifuge virtue does not belongi essentially ' pd in-iividually to the astringent, the bitter, or any other soluble prin-P?e, as the quantity of these increases by long boiling, while the vxr-. es ot the decoction decrease. Neither does the febrifuge virtue reside la that principle which destroys the emetic property of tartarized anti-,on.y? or precipitates iron, since the decoction contains more of it than e lr>fusion, while its virtues are evidently less$." Hence we may conclude, from these doubts and many others that have been raised, that ^uch is yet to be done before the effective principle of cinchonas in the Cure fevers be ascertained [|. We may, however, venture to state the examined 17 different kinds, but was not able to ascertain the names ' ^ trees from which they were obtained. ?ollSfc(lut'ncii of a chemical theu.y of the moile in which cinchona; acts rcl bady, Fabroni made some curious experiments to aseeitain the lr affinity of different cinchonas to oxygen. In imitating' bis ex perie'a'-K fWU^ t'ie ")ree ofjjcinal species, we found thatwhen half a drachm of *r C 1 ?' (hfcse barks in powder was separately mixed with half a Huid ounce of y r?i?B nitric acid, in similar vessels, the temperature of the atmosphere at the U'u-S ? tiqie 332 -Critical Analysis.
following as the known active constituents of cinchonas : chichon'in, res'ttly extractiv, gluten or ferment, volatile oil*, and tannin. 1 separated the resin in a pure state by evaporating the ethereal tincture on the surface of cold water ; and the gluten F ibroni found was separable by watei, oc asioning the spontaneous fermentation of the d. coction and infusion in summer, and decomposable by fermentation. They also contiir se* veral salts having lime for their basis, one ot which, peculiar to yellotf bark, Descamps, an apothecary at Lyons, discovered, and erroneously ascribed to it the febrifuge property ot the bark. Vauquelin found it to consist of lime, and a peculiar hitherto unknown acid, which he denominated kinic, and therefore termed the salt a kinate of limef. "As cinchona/bark occasionally varies in its powers, and is often ad Iterated with other inferior barks even by those who g ther it; arising either from ignorance, or from a fraudulent desire of more quickly completing their contracts ; it is of much importance to be .tble to extinguish good bark, and the best varieties from those of an inferior description The following directions for choosing b.:ik are those generally attended to in South America^ : The essential characteristics are colour, taste, and smell; the secondary or accidental ones are twtcrtof Coat, fracture, weight, thickness, and quill. The best bark of the first class is of an orange yellow colour; and the goodness decreases as the colour varies from this to a vety pale yellow. When of a dark colour between red and yellow it is always to be rejected ; as this colour designates either that it is of a bad specie , or that it has not been well pi'e" served from the air and moisture, which always diminish its virtues.
This dark colour, however, must not be confounded with a red colour in the inside which constitutes a distinct species. The taste of barkshould be bitter, but not nauseous nor very astringent, with a slight agreeable acidity just perceptible to the palate ; and when chewed it should not appear in threads, nor of much length. The odour of any of the barks is not very strong ; but when they have been well curt'd and preserved, it is always perceptible ; and the stronger it is, provided it be pleasant, the better may the bark be considered. The appearance of the coat or epidermis has led to many mistakes. It is merely accidental ; depending on the variation of the ground, and the exposure of the branches to the sun and air. Seven distinct appearances of the epi* time being 70?, and that of the acid 71", in the space of four minutes the heat produced rose the mercury in the thermometer as follows: The mixture was gradually swollen as the heat increased, and nitrous fumes weie given out, showing the evident decomposition of the acid. * Dr. Irwin first obtained a small portion of this oil. ?f-Annates de Chimie, lix. 1. c. The name of the acid is derived from kina Irina, an old appellation of the bark. Dr. Duncan proposes to call it cinchonic acid, as the present name would lead to the supposition that it is procured from kino. , J Extracted from a MS. in the author's possession, of Don Felix Dev^li, a respectable physician at. Lima, who has practised upwards of twenty-live years in South America.
?< -' dermis Thomson's Dispensatory 'J'JS ^<nmis arc remarked: 1. Negrillo, dark silver coat; 2. Crespillo, 8 ort curled ; 3. Pardo-obscuro, dark open leopard gray ; Pardo-clara, 'n t open gray ; 5, Lagartado. fine dark silver, lizard-like; 6. Blan-SUl^jimo, very pale; and 7. Ceniciento, ash coloured. The three first ti^ ^St' arKi belonS t0 ^"k produced on the highest mountains : *? others iank in the ore'er of their arrangement; the epidermis being s cracked and rough in proportion as the trees have been exposed 01 a scoiching sun. With regard to fracture, some of the \vo-st barks Je'K even and clean a. it cut with a knife, and some of the best have ? uvay a nioie or less splintery fracture*. The fibres of the fracture be-? br -harp an J snort indicate thj bark to have been gathered from mature 1 sncbes ; the long and threadlike from immature branches. The best' v^" into vogue by the many cures he performed with it in France, under the name of the English remedy, and his secret of preparing and exhibiting it was purchased by Louis XIV. and made public. Hcnce the origin of some of the appellations it has-had: as Cortex and Pubis Comitisstf> Cortex and Pulv-.s de Lvgo ; Jesuit's bark; alsa on account of its effects* Palos de calentura, or fever wood; and, from the place whence it was first brought, Peruvian bark. " It was introduced into practice for the cure of intermittent fever, and still retains the reputation it acquired as a remedy for that disease ; although, owing to peculiar idiosyncrasies and other accidental causcS> it has occasionally failed in this country in agues which were afterwards removed by other remedies, particularly arsenic. Some of these failures may perhaps have arisen from'the kind of the bark employed : for riotwithstanding the generally received opinion, that all the kinds of bark may be indifferently used, one for another, yet there is some leascn Wr the assertions of the Spanish and American physicians, that they vary i? other respects besides their degree of activity. By them the yellow bark* talis ay a, quitia naranjada*, is considered as directly febrifuge, and the best adapted for the cure of ague: the pale bark, quina amarilla, as only indirectly so, and better fitted for slow fevers and chronic debilities: while the red, corclada, quina roxa, is only lit to be used in cases of gangrene-]-, as its use is apt to be followed with disgustful nausea, severe vomiting, and insupportable colic. The differences of opinion with regard to the best time of giving it are now nearly settled. BoerhaaveJ and others recommended that the fever should be allowed to run on f?r ?ome time before it was administered ; but it is now generally agreed that the bark cannot be given too early after the stomach and,bowels are cleared by an emetic and cathartic. Dr. Cullen recommended the exhibition of it in a large dose or doses immediately before the accessions^ > but Morton's method of giving it directly after the hot stage of the p<** roxysm ceases, and repeating it in increased doses during the intermission, until the cold stage again returns, is now generally adopted. ^ may be safely given during the paroxysm, as practised by Dr. Clarke of Newcastle, but many stomachs are apt to nauseate itr at that time.
" In remittent fevers cinchona is found equally efficacious, the bowels however requiring to be kept more open. It renders the remissions distinct, and by degrees checks altogether the febrile action. In other affections depending on a similar state of habit, as hemicrania, periodical pains, spasms, chorea* hysteria, epilepsy, passive hasmorrhagy, and habitual frequently returning coughs, it is also found useful: but it does not prevent the continuance of those paroxysms of ague which form one of the constitutional symptoms of stricture of the urethra, and some other local affections ; and which can be removed only by removing the strictures and other sources of irritation.
* According to Condaiuine, this was the bark first, introduced in Europe* He says it yields by incision a yellow odorous resin ; and that the Jesuits of Paz (whence the best bark of.this species is still obtained) used to gather it with care, and send it to Rome, where ii was specific in agues. But the Loxa bark coming to Europe soon after, the two kinds were confounded together# t Zca, Anales de Hist. Nat. 1. c. Ilushworth discovered the efficacy of red bark in gangrene. + Aphorismi, &c. /67.
? Mat, Med. ii, 07.' " In continued fevers of the typhoid type, particularly when these *re attended with symptoms'of putridity, as'in jail-fever, cynanche Maligna, and scarlatina njaligna, confluent small-pox, and in putrid Measles, the bark must be regarded as one of the most valuable remeies.
X'he administration of it in pure typhus has been of late years tived till the increased excitement is presumed to be subdued, and yniptoms of great debility make their appearance, or until the morbid \e.it be carried off, and the skin opened. Several eminent modern phye'cians*, however, lecommend it to be given early in the disease, and persevered in ; but from our own experience we are inclined to con-^ r the former the safer practice, and believe that the best effects wiil produced from the cinchona, when its use, in pure typhus, is not egun till the skin becomes moist, the tongue is in part cleaned, and j^e urine deposits a critical sediment. In the other febrile diseases, >vever, above mentioned, it should be given in as large doses as the omach will bear, as soon as the typhoid symptoms become evident, u continued through every period of the disease. ' .Cinchona was first conjectured to be useful in gout by Sydenham, m some cases its efficacy is sufficiently evident. In acute rheuma-I?tT1 ?dso, Dr. Haygarth has lately strongly recommended it to be &lve", after the mannef of Morton, Hulse, and Fothergiil, from the c?mmencement of the disease ; the stomach and bowels being previously , fmptied by means of antimonial preparations. In our own practice we -r-ave kund it useful only after the liberal exhibition of calomel, tartazcd antimony, and opium, when the pains have in some degree abated, pulse has become softer. phthisis, bark is found beneficial when the accompanying hectic I 1 s on mure of the intermittent form than usual ; when the debility is nsiderabb, and blood is mixed in the sputa : and in several cases of J?ia, when, after repeated large bleedings ,and evacuations, the Se continued hard and thrilling, and the blood buffy, although the pectoration was free and the skm open, we have seen bark produce ?^happiest effects.
In various cutaneous diseases, as lichen agrius, and lividus, and pur-^ <lT > in erysipelas, and extensive ulcerations both from common incarnation and venereal affections^ ; in the termination of ail acute ? s^es after the urgent symptoms are subdued ; and in dyspepsia j chrocf* ?-bility?anc^ nervous affections, the use of cinchona is found to be 1 ? A ^,e;ltest advantage.
.. a local remedy, bark is sometimes used in the form of gargle in d 'gnant sore throat and aphthous affections ; and as a'wash to foetid odngienous sores. Powerful effects also are said to have been produced uf ^ s-vstern by frictions with the extract, softened by saliva or oil, fo tbe thiShs anc^ other parts of the body ; but Denman says he f nd advantage from its use as a clyster in the low state of puerperal ad e*' -'n w^ch ^ has been highly extolled. It may be efficaciously